Benefits of manual vacuum aspiration for abortion
Bibliographic record
Abstract
Manual vacuum aspiration (MVA) was designed for use in low-resource settings and is associated with lower costs compared with electric vacuum aspiration (EVA) [1]. A systematic review of 10 trials comparing MVA with EVA found no statistically significant differences in complete abortion rates or participant satisfaction; in addition, less blood loss and less severe pain were reported for the MVA procedures [2]. These findings have led to an increase in MVA use in high-resource settings; a survey of National Abortion Federation clinics in the USA and Canada found that 49% of abortion providers selectively use MVA [3]. Most licensing bodies require that the tubing used for EVA be discarded after each use. This is based on international standards such those set by the Center for Disease Control in the Guideline for Disinfection and Sterilization in Healthcare Facilities [4], in which it is stated that “[a] reused single-use device will have to comply with the same regulatory requirements of the device when it was originally manufactured.” By contrast, MVA involves the use of a plastic reusable syringe (e.g. the Ipas EasyGrip cannula [Ipas, Chapel Hill, NC, USA]). Manual vacuum aspiration has been used since 2008 at the Everywoman's Health Centre, Vancouver, Canada—which is a free-standing urban abortion clinic—for all procedures involving women at less than 10 weeks (69 days) of pregnancy. Each set of tubing for EVA weighs 293 g. In 2009, 2255 MVA procedures were carried out at the center, resulting in 660 kg less plastic tubing being discarded. The Ipas syringes are reprocessed using accelerated hydrogen peroxide, so the by-products are water and oxygen only. Each syringe weighs 108 g. There are currently 15 syringes at the clinic, each of which lasts for approximately 3 years, resulting in around 0.5 kg of plastic syringes being discarded each year. If EVA had been performed, the cost of the tubing discarded for the 2255 procedures undertaken in 2009 would have been Can$14,094 (with each set of tubing costing Can$6.25). The cost of the discarded MVA syringes was approximately Can$250 (5 syringes at Can$50 each) and the cost of the reprocessing solution was Can$510 (Can$10 per week for 51 weeks). The cost of reprocessing the syringes for each procedure—which involved taking the pieces apart, rinsing them, placing them in the reprocessing solution for 5 minutes, and drying and reassembling the unit—was Can$4698 (Can$25 per hour × 5 minutes × 2255 syringes). As a result, the cost saving for using MVA instead of EVA for 1 year was Can$8636. Manual vacuum aspiration is as effective as EVA for induced abortion and for completion of spontaneous abortion in early pregnancy and is associated with less pain and blood loss. It is also less expensive and less damaging to the environment, owing to the reduced amount of material discarded for each procedure. Manual vacuum aspiration should be recommended for use in induced abortion and completion of spontaneous abortion in early pregnancy. The authors have no conflicts of interest.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".